Cerebrospinal fluid adenosine deaminase levels and adverse neurological outcome in pediatric tuberculous meningitis.
ABSTRACT There is a lack of data on the prognostic significance of changes in cerebrospinal fluid (CSF) parameters in tuberculous meningitis. Our objective was to determine whether changes in CSF parameters are associated with poor neurological outcome in tuberculous meningitis.
We conducted a prospective cohort study on children admitted with a diagnosis of tuberculous meningitis to Government General Hospital in Kakinada, India. On admission, CSF parameters including cell count with fraction of lymphocytes and neutrophil leukocytes, glucose, protein, lactic dehydrogenase (LDH), and adenosine deaminase (ADA) levels were measured. We compared levels in children with and without adverse neurological outcome.
A total of 26 children was enrolled over a 2-year period. Ten had an adverse neurological outcome. Six had permanent neurological deficits (four hemiplegia and two cranial nerve palsies), two a hydrocephalus and two died. There was no significant (p>0.05) difference in age, gender and in CSF parameters, including cell count, lymphocyte and neutrophil leukocyte fraction, glucose, protein, and LDH levels between patients with and without adverse neurological outcome. Patients with adverse outcome had with a mean (SD) of 17.1 (3.2) IU/l a significantly higher ADA level than patients without, who had a mean (SD) level of 11.3 (2.7) IU/l (p<0.001, t-test).
Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.
Article: Tuberculosis in children: an update.[Show abstract] [Hide abstract]
ABSTRACT: TB is a common and serious global infection that is spread exclusively from person to person. The initial infection in most healthy people leads to LTBI 95% of the time, but untreated individuals have a 5% to 10% lifetime risk for reactivating their infection to develop highly infectious cavitary pulmonary TB or extrapulmonary disease. Following primary infection progressive disease is more likely to develop in children younger than 5 years old or those who are immunocompromised, particularly those with HIV infection. The diagnosis of TB in most of the world depends on the presence of a clinical illness typical for TB in concert with radiographic changes, the presence of AFB in sputum, or a positive TST. Newer methods of in vitro stimulation of T lymphocytes from TB-infected people to produce interferon may be more accurate than a TST but have yet to be well studied in children. Treatment of children with LTBI is generally 9 months of daily isoniazid unless the child has been in contact with an adult with known isoniazid-resistant TB. For active TB, children generally are treated for 6 months with an initial 2 months of isoniazid, rifampin, and pyrazinamide. Where exposure to an isoniazid-resistant strain is likely, ethambutol is added. After 2 months, pyrazinamide is discontinued unless the patient has been confirmed to have been infected with a resistant strain of M. tuberculosis. BCG, rarely used in the United States, is still considered important to prevent meningitis and miliary disease in very young children in areas of the world with a high prevalence of TB.Advances in Pediatrics 02/2006; 53:279-322.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective We studied the possibility that the laboratory tests β-trace protein and cystatin C in cerebrospinal fluid could discriminate the existence or absence of a bacterial meningitis, compared to other tests such as glucose, protein, polymorphonuclear leukocytes count, neuron-specific enolase, adenosine deaminase and C-reactive protein, using Gram staining and bacterial cultures as reference techniques. Material and method We analyzed 73 cerebrospinal fluid samples, divided into 3 groups: control group, bacterial meningitis group, and a third group of other diseases with neurological repercussions, including viral meningitis. Results The control group was compared against the bacterial meningitis group and the group of diverse diseases, and the last 2 were both compared. Significant differences were observed between the bacterial meningitis group and the control group. Furthermore, a diagnosis algorithm was developed to differentiate bacterial meningitis from the other groups, based on the levels of glucose, β-trace protein, cystatin C and the polymorphonuclear leukocytes count. Conclusions Despite the small number of bacterial meningitis cases included, this study suggests that, β-trace protein and cystatin C could be good laboratory tests in order to discriminate a bacterial aetiology.Revista del Laboratorio Clínico. 03/2008; 1(1).